Patient involvement has always been integral to NHS services, so it is vital that commissioners now ensure local people respond to engagement opportunities, says David Stout.

Patient and public engagement has always played an important role in healthcare. Not only does it add clarity about the best way to shape and deliver local services, it allows patients and taxpayers to have a say in how NHS resources are deployed.

Involving patients and the public in individual and collective decisions about their care has been cited as a way of securing a more patient-centred approach to healthcare delivery, fostering a sense of ownership among patients and moderating demand for healthcare resources.

With the NHS facing the biggest financial challenge in its history, commissioners will have to make some difficult decisions about how services are planned while making the most of the resources they have. It will be particularly important to ensure local communities are on board when these difficult decisions are made.

The NHS Act 2006 places a statutory duty on all NHS organisations to involve patients and their representatives in decisions about services. Engagement can take various forms. For instance, it could mean being involved in consultation on proposals to change certain local services, or helping shape decisions about how to prioritise different services.

Under the Health Bill’s proposals, all new commissioners are expected to have an approach to engagement in place before achieving authorisation by the NHS commissioning Board.

With the bill putting heavy emphasis on the need to involve more clinicians and patients in decisions about how care is planned it is essential that clinical commissioning groups plan from an early stage how they intend to engage with their local communities.

Making headway

The experiences of some pathfinders which have already made headway on local engagement plans suggest that while successful engagement requires some effort to get up and running initially, once established it need not add significantly to their commissioning workload. More importantly, they realise that it can provide extremely valuable information for buying and planning high quality services.

This is not just about doing the right thing, as there can be financial benefits too. Evidence from Turning Point shows that some integrated early intervention programmes stemming from community-led commissioning generated savings of over £2.50 for every £1 spent.

At a recent NHS Confederation roundtable on engagement, participants said significant commitment to and enthusiasm for it already existed within many CCGs.

However, the approaches used to date by the NHS all require an investment of time, capacity and money to be successful. Depending on the level of management allowance made available to CCGs, they may not have sufficient resources to undertake extensive engagement work in relation to every aspect of their commissioning activities.

Possible solutions to this problem include undertaking engagement work at a “federated” level, ie, across several CCGs, to make it cost effective; drawing on any available primary care trust cluster resource; being innovative and entrepreneurial in identifying other funding locally or nationally; and/or using local existing groups.

GPs’ new responsibility for commissioning means they will have to consider issues on a wider scale than they currently do as they will be planning for whole communities, not just individual practice populations. 

These populations will be broader than the sum of individual member CCG practice lists and may include groups that are not at present well represented in engagement exercises, patients who are not at present registered with a GP and people who are not themselves receiving treatment.

It is essential for CCGs beginning to develop engagement strategies to be aware of the range of existing mechanisms available to them and to make use of the resources currently available in primary care trust clusters. This can be done by enlisting PCT support in developing new architecture for engagement where necessary.

Existing mechanisms

Participants in the roundtable felt that one of the most urgent priorities for CCGs related to mapping and understanding the range of existing engagement mechanisms and sources of intelligence available and beginning to work these into commissioning activity.

As well as existing practice based patient participation groups, commissioners can make use of community based organisations working to improve health and social care services. Local improvement networks, local HealthWatch bodies (which are to replace the networks) and third sector organisations will all be relevant. 

Local foundation trust memberships may also provide a route to engagement, but commissioners will need to consider members’ affiliation to their foundation trust.

In addition, local authorities may have existing engagement mechanisms which can be used to inform strategic planning. No doubt health and wellbeing boards, which have their own statutory responsibilities, will also play a role.

Regardless of the approach to engaging with communities, there are a number of factors to consider. Most importantly, leader-level support must be present in CCGs, along with an understanding of why good engagement can benefit both commissioners and patients.

Clarity of purpose is also vital – people will not want to get involved in a time consuming process unless they are clear about what they are setting out to achieve. Engagement requires time and effort, so the commitment should not be underestimated. It should reap long term rewards.

Patient and public engagement must be at the heart of planning, commissioning and delivering care in the new world NHS.

Without it, CCGs will not achieve the outcomes vital for delivering the large efficiency savings required alongside care tailored to suit the needs of the local community.

They will also struggle to secure the support of patients about why some difficult decisions, such as those concerning the reconfiguration of services, are made with patients’ interests in mind.